There are "enormous barriers" to reaching the goal of the World Health Organization's 3 by 5 Initiative to treat three million people with antiretroviral drugs by the end of 2005, an editorial in the May 7 issue of the Lancetsays. Although there have been "substantial success[es]" for the initiative -- including elevating antiretroviral treatment to a "mainstream" U.N. program, tripling the initial target of the number of outlets providing drugs, improving the focus on HIV prevention strategies and exceeding by 20,000 people the December 2004 treatment target of 700,000 people on antiretrovirals worldwide -- "closer inspection" of the measures taken to scale-up treatment "reveals important gaps between the achieved and published targets," the editorial says. The program's financial resources of $163 million is below the $174 million needed, and the number of WHO staff members assigned to the initiative "is well below what it should be," according to the Lancet. Even more "crucially," only 30 countries so far have established treatment goals, although the initiative aimed to have 50 countries with established targets by December 2004, the editorial says. In addition, India, South Africa and Nigeria "in particular" need to demonstrate their commitment to the initiative in order for the overall treatment target to be met within the next eight months, according to WHO HIV/AIDS Programme Director Jim Yong Kim, the editorial says. If the 3 by 5 Initiative had the "political clout" to influence South Africa into implementing its recommendations, then the three million treatment target would "more likely" be attained, according to the Lancet. "Without South Africa on board, with its 837,000 people affected by HIV/AIDS and its leadership position within Africa, 3 by 5 is but a pipe dream," the editorial says.

Recommendations
The 58th World Health Assembly, which begins on May 16, must give "urgent focus" to the initiative, the Lancet says. Strategies to put pressure on individual governments' ministries of health also must be enacted, particularly in sub-Saharan Africa, the editorial says, adding that pharmaceutical companies could "help with increased antiretroviral donations." Although it is "essential now, and beyond 2005," that organizations such as WHO, UNAIDS, the World Bank and the Global Fund To Fight AIDS, Tuberculosis and Malaria demonstrate "[c]ontinued leadership," individual countries also "need to act," according to the Lancet. "For what was a modest [treatment] target, it is tragic that many of those with HIV/AIDS who desperately need treatment will not receive it by the end of 2005 and will die as a result," the editorial says (Lancet, 5/7).

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